Intermittent fever

“ But the reaction goes far beyond any normal physiological state. The face becomes flushed and the eyes injected, and the patient complains of headache, thirst, dryness and heat of the surface; he will not permit any covering, and constantly shifts his place in the bed in the hope that some new position may afford him more comfort. Nausea and vomiting are commonly present. If the fever runs high, delirium is apt to occur. The thermometer seldom shows a temperature above 105°, but I have seen 106.5° recorded in the axilla in the hot stage of a paroxysm of simple intermittent fever. ”

“ Those in which the succession of cold, hot and sweating stages is lacking. There is not the frank well-defined chill of the former group, [28] so that the term dumb chill is frequently applied. With the possible exception of the first paroxysm the temperature tends to remain well above normal giving a continuous, or at any rate a remittent type of fever, instead of the intermittent temperature curve of the benign infections. The designation remittent fever, is often applied to such fevers. Clinically there is a resemblance to typhoid fever. ”

“ If the first paroxysm should not cease within the twenty-four hours, the fever is not reckoned as an intermittent, but as a remittent.
Remittent is a not unusual form of the malarial process in tropical and subtropical countries, and in some localities or in some seasons it is more common than intermittent. It may be said to arise out of that type of intermittent in which the cold stage is shortened while the hot stage tends to be prolonged. A certain abatement or remission of the fever takes place, with or without sweating, but there is no true intermission or interval of absolute apyrexia. ”

“ Pure air, gentle exercise, and agreeable society removed the debility both of body and mind of this premature and temporary old age. I met with a [290] few cases, in which the yellow colour continued for several weeks after the patient's recovery from all the other symptoms of the fever. It was removed most speedily and effectually by two or three moderate doses of calomel and rhubarb.
A feeble and irregular intermittent was very troublesome in some people, after an acute attack of the fever. It yielded gradually to camomile or snake-root tea, and country air. ”

“ With these febrile symptoms there may be associated uneasiness in the right hypochondrium, acute pain, or a feeling of weight and pressure, with jaundice, etc. The fever is septicæmic, intermittent, or remittent if it have any special type. In the septicæmic form the rigors are severe, occur irregularly, sometimes daily, sometimes twice a day, and at intervals of two or three days or longer; the fever rises to a high point—104°, 105°, or higher—and the sweats are profuse. ”

“ It prevails chiefly in cool and cold weather, but is never epidemic; for the excreted matters which produce the fever do not float in the external atmosphere, nor are they communicated, so as to produce disease, more than a few feet from the persons who exhale them. They are sometimes communicated by means of the clothes which have been worn by the sick, and there have been instances in which the fever has been produced by persons who had not been confined by it, but who had previously been exposed to all the causes which generate it. ”

“ The contagion, -like that of typhus, appears to be most active in the immediate vicinity of the patient and to be greatly lessened by the access of fresh air. It is capable of being conveyed by clothing. The incubation of the disease is about one week. The symptoms of the fever then show themselves with great abruptness and violence by a rigor, accompanied with pains in the limbs and severe headache. ”

“ As a rule the disease begins with headache, stiffness of the neck and chilly sensations. There may be vomiting, and the temperature is raised. The mind is often confused, and the patient may be delirious. The skin eruption, which occurs especially on the back and about the joints, and which is responsible for the name “spotted fever,” is not very frequently seen, and can hardly ever be detected on a dark skin. In very bad cases there is violent delirium, laboured breathing, and a purulent discharge from the nostrils. ”

“ They are at all times too serious to be left, with safety, in the hands of the domestic practitioner. Medical aid, therefore, should be instantly sought for, as much depends on proper management during the first stage of the fever. The approach of this disease may be known, by attending to the symptoms which precede the eruption, in the following order: First, the patient complains of shivering, with a sense of coldness, a thin watery discharge from the nose, hoarseness, cough, and a continued flow of tears from the eyes, which appear red and inflamed. ”

“ He continues feverish and at times perspires profusely. Gradually, however, although the patient is anæmic and weak, subjective symptoms become less urgent; he sleeps well now, he has no delirium at night, and he can take his food, and this although the body temperature may still range slightly above the normal. Then once more, and perhaps over and over again, fever with all the former symptoms gradually returns ”

“ We have already seen how, in the course of various diseases, the pulse is quickened, and the temperature raised, constituting that state which we commonly call fever, but as the local ailment subsides the fever disappears. There is, apart from smallpox, measles, and the other so-called eruptive fevers, only one real essential fever commonly met with in childhood, and that is what the doctors call typhoid fever. ”

“ The natural crisis is various by nasal hemorrhage, by sweats, turbid urine, diarrhœa; and the duration of the fever from four to eleven days. The Febris Diaria of a few days continuance, is a sort of minor or infant species, an appendix of the inflammatory: it begins suddenly with nausea, vomiting, shivering, cold, headach, lassitude, heat of the skin, flushed face, restlessness, or disturbed sleep, strong quick pulse: and is rarely dangerous. ”

“ On the occurrence of crisis the erythematous condition of the skin, if it has not already disappeared, rapidly subsides. In a proportion of cases, and particularly in certain epidemics, crisis does not occur, the fever slowly declining during a period of three or four days. Thus the urgent symptoms abate, and the patient rapidly, or more slowly, passes from what, in many cases, may be described as the agony of the first stage to the comparative calm and comfort of the second. ”

“ The periodical pains in the head, eyes, ears, jaws, hips, and back, which occur in the sickly autumnal months, and which impart no fulness, force, nor frequency to the pulse, are all misplaced fevers. There are, besides these, many other local morbid affections, which are less suspected of belonging to febrile diseases. The nature of these states of fever may easily be understood, by recollecting one of the laws of sensation, that is, that certain impressions, which excite neither sensation nor motion in the part of the body to which they are applied, excite both in another part. ”

“ A favorable termination is indicated by a gradual amelioration of all the symptoms, or sometimes by profuse perspiration, sudden cessation of nausea, rapid return of the pulse to its natural fullness and strength, or other marked event, which seems to indicate a crisis in the disease.
The symptoms of yellow fever vary exceedingly at different times, in different localities, and in different persons. Sometimes a person is smitten with the disease as with apoplexy, falls into a profound collapse, and dies in a few hours. ”

“ The next fact in favor of the infectious character of a cold is that it begins with a chill, followed with a fever, runs a definite self-limited course, and, barring complications, gets well of itself in a certain time, just like the measles, scarlet fever, pneumonia, or any other frank infection.
Colds are also followed by inflammations, or toxic attacks in other organs of the body, lungs, stomach, bowels, heart, kidneys, nerves, etc., just like diphtheria, scarlet fever, or typhoid, only, of course, of milder form and less frequently. ”

“ These differences are sometimes owing to diversities in the constitution and habits of the patient, sometimes to variations in the character of the epidemic, and are sometimes not readily explainable. One of these is the mild form, in which the symptoms are those of moderate fever, and in which the disease may run its course in seven days. In this form the temperature may never rise above 102° F., the eruption be absent or very scanty, and the characteristic stupor or dulness be wholly wanting. Unless complications arise recovery invariably takes place. ”

“ After a few hours, or within a day, the fever begins to rise rapidly and is often associated with shivering attacks. The face now becomes hot and flushed, the conjunctivae markedly injected, the pupils dilated, and the eyes rather staring. The temperature is as a rule from 102° to 104°F., occasionally higher, with a tendency to rather marked remissions and, on the whole, of great irregularity of the fever curve. The pulse is rapid and shows early indications of the extreme toxic effect exercised upon the heart. Cardiac weakness is a marked feature of plague. ”

“ A week's study of the temperature, if no rose-spots appear, will be needed before the diagnosis can be made. There is not much difficulty in making the distinction when the attack has reached its second week. At this period in catarrh of the bowel the high fever, with regular morning remissions and evening exacerbations, is not constant, as in typhoid fever; there is tenderness on pressure over the abdomen and gurgling, but no great meteorism; sibilant râles are not heard in the chest; there are no rose-spots; rarely cerebral symptoms except insomnia; and delirium is uncommon. ”

“ A gentle sweat, or moisture on the skin, greatly promotes the eruption; but, when the skin is dry, the eruption is both more painful and dangerous.
Sometimes this is a primary disease; but it is much oftener only a symptom of some other malady, as the small-pox, measles, ardent, putrid, or nervous fever, &c. In all these cases it is generally the effect of too hot a regimen or medicines.
The miliary fever chiefly attacks the idle and the phlegmatic, or persons of a relaxed habit. The young and the aged are more liable to it than those in the vigour and prime of life. ”

“ When the fever attacks suddenly, it always begins with an uneasy sensation of excessive cold, accompanied with debility and loss of appetite; frequently the cold is attended with shivering, oppression about the heart, and sickness at stomach, or vomiting.
Fevers are divided into continual, remitting, intermitting, and such as are attended with cutaneous eruption or topical inflammation, as the small-pox, erysipelas, &c. By a continual fever is meant 142that which never leaves the patient during the whole course of the disease, or which shews no remarkable increase or abatement in the symptoms. ”

“ The rigor stage is relatively less marked; the pyrexial stage is more prolonged, and is often characterized by a tendency to adynamic conditions, together with vomiting, intestinal catarrh, pains in the limbs, anorexia, severe headache, and depression. After apparent recovery from the fever there is a great proneness to relapse at more or less definite intervals of from eight to fourteen days. Such fevers are accompanied by rapid destruction of corpuscles, and are usually followed by marked cachexia. At any time in their course symptoms of the gravest character may declare themselves. ”

“ One attack usually confers immunity.
Symptoms.—Incubation is about three to four days. There may be a fore-warning period, but the attack is usually sudden, with chills, headache, backache, rise in fever, and general feverish symptoms, vomiting, and constipation. Early in this disease the face is flushed, while the conjunctiva and the mucous membrane lining the eyelids is congested and slightly jaundiced. Fever is 102 or 103 degrees, and falls gradually after one to three days. Pulse is slow, and while the temperature rises, it again falls. ”

“ Most cases of perimetritis and parametritis terminate in five or ten days, the fever and other symptoms gradually subsiding. When, as may happen in exceptional instances, the temperature falls suddenly from a high degree to one below the normal level, the body grows icy cold, the pulse becomes small and irregular, and symptoms of collapse develop. But in twelve to twenty-four hours the symptoms of collapse subside, and the disease reaches its end with a disappearance of the alarming manifestations. ”

“ Hectic fever is now fully established; the eye is unusually bright and pearly, with dilated pupils, which gives a peculiar expression; the paroxysms of coughing exhaust the patient, and he gasps and pants for breath. The tongue now becomes furred, the patient thirsty, the bowels constipated, and all the functions are irregularly performed. Another remission may now occur, and the patient be able to resume light employment, for an indefinite length of time, which we have known to extend over three or four years, when the symptoms again return. ”

“ The disease, in fact, is so slightly contagious that many excellent observers have doubted if it be so at all. It is probable that certain meteorological conditions, such as a high temperature, a defective supply of ozone, or a peculiar electrical state, may be necessary for the production of the poison of enteric fever; and thus, nuisances which are offensive to the senses may exist for a long time without producing the disease. ”